Medical Report Check

1. Patient Information

• Name: [Patient’s Full Name]
• Date of Birth: [DOB]
• Patient ID/Record Number: [ID Number]
• Date of Report: [Date]

2. Referring Doctor Information

• Doctor’s Name: [Doctor’s Full Name]
• Specialty: [Specialization]
• Contact Information: [Phone Number, Email Address]

3. Medical History

• Past Medical Conditions: List any relevant medical conditions.
• Surgical History: Include dates and types of surgeries, if any.
• Allergies: Note any known allergies to medications, foods, etc.
• Family Medical History: Summarize relevant family medical background.

4. Current Medications

• List all medications the patient is currently taking, including dosage and frequency.

5. Presenting Complaints

• Describe the symptoms and issues the patient is currently experiencing.

6. Examination Findings

• Vital Signs: Document the patient’s blood pressure, heart rate, temperature, and other vital signs.
• Physical Examination: Note any relevant findings, such as pain, swelling, or abnormalities.

7. Diagnosis

• State the diagnosis based on examination findings, tests, and other evaluations.

8. Investigations and Test Results

• List any diagnostic tests conducted (e.g., blood tests, X-rays) and provide a summary of results.

9. Treatment Plan

• Outline the recommended treatments, including medications, lifestyle changes, or referrals to specialists.

10. Recommendations and Follow-Up

• Provide any additional recommendations, such as rest, therapy, or dietary adjustments.
• Specify when the patient should return for a follow-up visit.

11. Doctor’s Signature

• Doctor’s Name and Signature:
• Date: [Date Signed]